两种术式治疗单节段神经根型颈椎病的比较

Intervertebral disc replacement versus anterior cervical decompression and fusion for single-level cervical spondylotic ra⁃ diculopathy

摘要:

［目的］ 比较椎间盘置换和前路减压融合治疗单节段神经根型颈椎病的临床疗效。［方法］ 回顾性分析 2018 年 1 月 —2019 年 1 月手术治疗的单节段神经根型颈椎病 63 例患者的临床资料，根据术前医患沟通结果，将患者分为两组，其中，置换组 30 例，融合组 33 例。比较两组围手术期、随访和影像资料。［结果］两组患者均顺利完成手术，无严重并发症。两组手术时间、切口总长度、术中失血量、术中透视次数、下地行走时间及住院时间的差异均无统计学意义 （P>0.05）。两组患者随访时间均在 24 个月以上，与术前相比，末次随访时两组 VAS、NDI 评分均显著降低 （P<0.05），而 JOA 评分前显著增加 （P< 0.05）。末次随访时两组间 VAS、NDI 和 JOA 评分的差异均无统计学意义（P>0.05）。影像方面，与术前相比，末次随访时融合组整体 ROM 显著减小（P<0.05）。末次随访时，置换组局部 Cobb 角，C2~C7 Cobb 角和整体 ROM 均优于融合组（P<0.05）。［结论］单节段神经根型颈椎病治疗中置换组可以获得与融合组同样的临床疗效，而且可以保留更好的颈椎活动度。

Abstract:

[Objective] To compare the clinical outcomes of intervertebral disc replacement (IDR) and anterior cervical decompression and fusion (ACDF) for treatment of single-level cervical spondylotic radiculopathy. [Methods] A retrospective study was performed on 63 patients who received surgical treatment for single-segment cervical spondylotic radiculopathy from January 2018 to January 2019. Accord- ing to consequence of the preoperative doctor-patient communication, the patients were divided into two groups. Of them, 30 patients under- went IDR, while the remaining 33 patients had ACDF performed. Perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operations completed successfully without serious complications. There were no significant differences in operative time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, time to resume walking and hospital stay between the two groups (P＞0.05) . All patients in both groups were followed up for more than 24 months. Com- pared with those before surgery, the VAS and NDI scores significantly decreased (P＜0.05) , while JOA scores significantly increased at the latest follow-up (P＜0.05) . However, there were no significant differences in VAS, NDI and JOA scores between the two groups at the last follow-up (P＞0.05) . In terms of imaging evaluation, the overall ROM of the fusion group significantly reduced at the latest follow-up com- pared with that preoperatively (P＜0.05) . At the latest follow-up, the IDR group proved significantly superior to the ACDF group regarding to local Cobb angle, C₂~C₇ Cobb angle and overall ROM (P＜0.05) . [Conclusion] Both IDR and ACDF achieve satisfactory and similar clini- cal outcomes for single-level cervical spondylotic radiculopathy, by contrast, the IDR has an advantage of retaining cervical motion in some extent.